Food`s Just Half Of Diet Solution

The Other Key Is Behavior Modification

March 03, 1988|By William Rice.

SAN DIEGO — Dr. Kelly Brownell is one of the few people in America trying to present dieting as a complex subject rather than something quick and easy. The reason may be that he is a psychologist rather than a huckster.

Part one of Brownell`s message is simple: There is no single cure-all for obesity.

Part two is simple, too: The only long-range solution to being overweight is behavior modification. (Not incidentally, the doctor, who is on the faculty of the University of Pennsylvania`s School of Medicine, is president-elect of the Association for the Advancement of Behavioral Therapy.)

What`s not so simple, he suggested, is the vast wasteland of

misconception and misinformation that separates part one from two.

In a speech to food writers attending the recent Pillsbury Bake-Off here, Brownell predicted a change in the faddish assumption that everyone should be thin, and can be if only they exercise self-discipline.

``I suspect that dieting is bad in some people but good in others,`` he said, suggesting the focus of obesity treatment should swing toward first asking, ``Who should lose weight?`` and then ``Who can lose weight?``

Women tend to add body weight on hips and thighs, men in the stomach. In relation to coronary disease, diabetes, hypertension and lipid disorders, he explained, ``we know the person with a certain amount of weight above the waist is at greater risk than if the same amount of weight is below the waist. The health risk isn`t sex-specific, it`s site specific.``

Other research shows that below-the-waist weight on women, protected by something called alpha receptors, is more difficult to lose than fat with beta receptors above the waist.

Citing ``yo-yo`` or ``roller coaster`` diets as potentially harmful, Brownell explained how the very act of losing weight may influence an individual`s ability to shed pounds in the future. Ongoing studies of high school and college wrestlers, many of whom lose and gain weight in weekly cycles, are validating earlier studies of laboratory rats.

In the lab, he said, fat rats that alternated between restricted and high-fat diets required 21 days to achieve normal weight during their first crash diet and 46 days during the second. They were fed the same number of calories each time. The upward surge to obesity took 46 days on the first cycle, yet only 14 on the second.

``We`ve seen weight stick, even with a diet of 900 calories a day,`` he said. ``It may be the patient`s metabolism has been lowered or the body may be protecting itself, reacting to this diet to forestall a later diet.

``The belief that a calorie is a calorie, and 3,500 calories equal a pound, starts falling apart when you start tampering with the body`s physiology. This hints that a yo-yo diet may be worse than no diet at all. Surely (as one loses more slowly and regains weight more quickly) there is a psychological cost and possible medical and physical dangers, too.``

The alternative approach to weight loss which Brownell and colleagues from a number of other universities have been working on is called LEARN, a program of behavior modification based on lifestyle, exercise, attitude, relationships and nutrition.

``We match each individual to an appropriate treatment,`` he said. ``The program is unique because we place equal emphasis on the different aspects of weight reduction. We emphasize these components so people don`t come in with the idea that all they have to do is exercise, or eat the right foods, or eat slowly.``

Taking weight off may be less than half the problem, the doctor concluded.

Once a person has lost weight by dieting, all too often the pattern is

``lapse, relapse, collapse,`` he said, suggesting that eating a piece of cake isn`t the end of the world, and needn`t be the end of a diet.